680142.pdfFOOTED ON KROLL MAP NO.: RMIT
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NUMBERft%t 0142
4146 DEPARTMENT Appm=t FM vh� i
Inside Heavy Lines WV I
AIT APPLICATION JOB ADDRESS tw
a ;A a 'Re
)R NAME Ol� BIPSINEHII)
SIDE YARD SETBACK STREET SETBACK. REAR YARD SETBACK
T
I ADDRESS I
USE ZONE LOT AREA VACANT SITE
r 2
TELEPHONE NUMISEA YES NO Z
RLALNCE NUMBER
4 0 n &N. UEIGIrr BUILDING AREA VA
PLOT P kN APPROVED
STREET RIW THIS PROPERTY
EXISTING STREET R/W-9_!;:L.FT. DEFICIENCY
TELEPHONE NUMBER
P PLAN ST R/W3 �5-0 .1"
we, r
TELEPHONE
BE NUMBEW CITY LICEN
15/_ 6 401:25 1 —
[on of Property (Show 13CLOW or Attach F01
,5- Lamqr A"p
;. 2-
4
RESIDENTIAL
G 8
LINE
19 NEW
NON-RESIDENTIALI
El
SIGN
0
RETAINING
---
WALL
DEMOLISH
ALTER
0
EXCAVATE
OR FILL
FENCE
( x Ft.)
.......... ..........
REPAIR
1:1
PRE -MOVE
INSP.
swim
POOL
S
NUMBER OF
DWELLING
02,
_rr
UNITS
qATURE OF WORK TO BE DONE
AL 1 11 1 1 1)
REMARKS
Z
ra
1( 1
;ONNECTION
VEP��
BY
TEST
PEAMI
NUMBER
tKS
TYPE OF CONSTR
7V
STRE, T IMPROVED
1[3 YES [:I ITO
0 YES ?q NO
ZI
0 1 Plan CheckN_44=._.I.—�
PROPOSED USE I BUILDING
J)Zwed i IV !V
PLOT PLAN (Indicate Sunning aftbacks, abutting streets) PLUMBING
11
t
N
BEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application: that the in-
formation given is correct; and that I am the owner, or the duly author-
lzed agent of the owner. I agree to comply with city and state laws regu. ATTENTION
latlng construction; and In doing the work authorized thereby. no person
will be employed in violation of the Labor Code of the State of Washington THIS PERMIT
relating to Workmen's Compensation Insurance. AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pletcdd,.1a.ilx monthV-� INSPECTION
iIG ATU W R 0 AG T) IJA'I'Z MUV�V DEPARTMENT
011
, ZZ 1"gq CITY OF
—7 1 EDMONDS
NO)M"' kpfica"ubject to Plats Check Fee rn 0-1107
This ]permit covers work to be done on private Property ONLY.
Any construction on the public domain (curbs. sidewalks, driveways,
marquees, etc.) will require separate Permission.
Valuation Fee Receipt
1 3 .0 - s;-n
APPLICATION APPROVAL
This application is not a pern-dt until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
WIN Xj WMA;
Paz
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